To estimate breast-feeding prevalence in Greece in 2007 and 2017, compare breast-feeding indicators and maternity hospital practices between these years, and investigate breast-feeding determinants.

Two national cross-sectional studies (2007 and 2017) using systematic cluster sampling of babies with the same sampling design, data collection and analysis methodology.

Telephone interview with babies’ mothers or fathers.

Representative sample of infants who participated in the national neonatal screening programme (n 549 in 2017, n 586 in 2007).

We found that breast-feeding indicators were higher in 2017 compared with 10 years before. In 2017, 94 % of mothers initiated breast-feeding. Breast-feeding rates were 80, 56 and 45 % by the end of the 1st, 4th and 6th completed month of age, respectively. At the same ages, 40, 25 and <1 % of babies, respectively, were exclusively breast-feeding. We also found early introduction of solid foods (after the 4th month of age). Maternity hospital practices favouring breast-feeding were more prevalent in 2017, but still suboptimal (63 % experienced rooming-in; 51 % experienced skin-to-skin contact in the first hour after birth; 19 % received free sample of infant formula on discharge).

We observed an increasing trend in all breast-feeding indicators in the past decade in Greece, but breast-feeding rates – particularly rates of exclusive breast-feeding – remain low. Systematic public health initiatives targeted to health professionals and mothers are needed in order to change the prevailing baby feeding ‘culture’ and successfully implement the WHO recommendations for exclusive breast-feeding during the first 6 months of life.

To recognize the causality of environmental factors (i.e. temperature, humidity and sun exposure) on nutritional variables, specifically body water balance and water-seeking behaviour.

Author perspective.

Global.

Not applicable.

A free-standing code supplement is provided to facilitate investigators in accessing meteorological data for incorporation into analyses related to nutrition and hydration.

Analytical models related to human hydration should account for the environment de rigueur.

To measure fatty acid composition, particularly whole-blood PUFA content, in acutely malnourished children and identify associations with markers of nutritional and health status.

PUFA were assessed in dried blood spots obtained from a cross-sectional study. Nutritional and health status were assessed by anthropometry, haemoglobinopathies, inflammation and blood counts.

Cambodia.

The study was conducted with 174 children aged 0·5–18 years with acute malnutrition.

Among total fatty acids (FA), the relative percentage of total PUFA was 20 % FA, with 14 % of the children having very low PUFA (mead acid (MA):arachidonic acid (AA) >0·02, n-6 docosapentaenoic acid:DHA >0·2 and total n-6:n-3 PUFA >10·5). Wasting was not associated with any PUFA. Stunting and low height were consistently positively associated with total PUFA and positively with n-6 PUFA. Height was positively associated with n-3 long-chain PUFA (LCPUFA). The presence of haemoglobinopathies or inflammation was positively associated with MA:AA, but not total PUFA. Elevated blood platelet counts were positively correlated with linoleic acid and appeared to be influenced by anaemia (P = 0·010) and inflammation (P = 0·002). Monocyte counts were high during inflammation (P = 0·052) and correlated positively with n-6 LCPUFA and n-3 LCPUFA.

Children with acute malnutrition or stunting had low PUFA, while elevated platelets and monocytes were associated with high PUFA. In acutely malnourished children, inflammation could lead to elevated blood cell counts resulting in increased whole-blood PUFA which does not reflect dietary intake or nutritional status.

To identify whether picky eating during childhood is associated with dietary intake, weight status and disordered eating behaviour during young adulthood.

A population-based study using data from young adults who responded online or by mail to the third wave of the Project EAT (Eating and Activity in Teens and Young Adults) study in 2008–2009. Participants retrospectively reported the extent to which they were a picky eater in childhood, sociodemographic characteristics, disordered eating behaviours, usual dietary intake, and weight and height.

Participants were initially recruited in the Minneapolis/St. Paul metropolitan area of Minnesota, USA, in 1998–1999.

The analytic sample included 2275 young adults (55 % female, 48 % non-Hispanic White, mean age 25·3 (sd 1·6) years).

Young adults who reported picky eating in childhood were found to currently have lower intakes of fruit, vegetables and whole grains, and more frequent intakes of snack foods, sugar-sweetened beverages and foods from fast-food restaurants. No associations were observed between picky eating in childhood and young adults’ weight status, use of weight-control strategies or report of binge eating.

While young adults who report picky eating during childhood are not at higher risk for disordered eating, those who were picky eaters tend to have less healthy dietary intake. Food preferences and dietary habits established by picky eaters during childhood may persist into adulthood.

To identify the prevalence of unhealthy dietary behaviours and their social-ecological influences in adolescents.

The study used a sequential explanatory mixed-methods design, which begins with the collection of quantitative data, followed by the collection of qualitative data to explain and enrich the quantitative findings. Quantitative data were collected via a global school-based student health survey and were analysed using quantitative approaches. Qualitative data were obtained via focus group discussions and were analysed thematically.

Middle and high secondary schools in Taza city, Morocco.

Our quantitative analyses included 764 students (14–19 years). For the qualitative part, seventeen focus group discussions were conducted with 100 participants (fifty-six adolescents, twenty-six parents and eighteen teachers).

Of total student participants, 46·1 % skipped breakfast, 60·6 % had inadequate intake of fruits and vegetables (F&V), 39·4 % consumed soft drinks and 28·0 % consumed fast foods. All of these dietary behaviours could coexist in the same person except for inadequate intake of F&V. Gender, academic performance, age, perceived family income and education level of mother were associated with unhealthy dietary behaviours. Qualitative findings identified seven themes regarding social-ecological influences on adolescents’ dietary behaviours: cognitive, affective/biological, lifestyle, outcome expectation, social network, accessibility/availability and macro-level influences.

The prevalence of unhealthy dietary behaviours in our study group is a concern. Dietary behaviours are the result of inseparable interactions among social-ecological influences. Modifiable factors identified may be useful when designing a future intervention aimed at improving breakfast and F&V consumption and reducing fast/snack-food consumption among adolescents.

To determine if specific dietary patterns are associated with risk of hypertension, type 2 diabetes mellitus (T2DM) and high BMI in four sites in Peru.

We analysed dietary patterns from a cohort of Peruvian adults in four geographical settings using latent class analysis. Associations with prevalence and incidence of hypertension, T2DM and high BMI were assessed using Poisson regression and generalised linear models, adjusted for potential confounders.

Four sites in Peru varying in degree of urbanisation.

Adults aged ≥35 years (n 3280).

We identified four distinct dietary patterns corresponding to different stages of the Peruvian nutrition transition, reflected by the foods frequently consumed in each pattern. Participants consuming the ‘stage 3’ diet, characterised by high proportional consumption of processed foods, animal products and low consumption of vegetables, mostly consumed in the semi-urban setting, showed the highest prevalence of all health outcomes (hypertension 32·1 %; T2DM 10·7 %; high BMI 75·1 %). Those with a more traditional ‘stage 1’ diet characterised by potato and vegetables, mostly consumed in the rural setting, had lower prevalence of hypertension (prevalence ratio; 95 CI: 0·57; 0·43, 0·75), T2DM (0·36; 0·16, 0·86) and high BMI (0·55; 0·48, 0·63) compared with the ‘stage 3’ diet. Incidence of hypertension was highest among individuals consuming the ‘stage 3’ diet (63·75 per 1000 person-years; 95 % CI 52·40, 77·55).

The study found more traditional diets were associated with a lower prevalence of three common chronic diseases, while prevalence of these diseases was higher with a diet high in processed foods and low in vegetables.

To examine adherence to a Mediterranean-like diet at age 9–10 years in relation to onset of breast development (thelarche) and first menstruation (menarche).

We evaluated the associations of adherence to a Mediterranean-like diet (measured by an adapted Mediterranean-like Diet Score, range 0–9) with thelarche at baseline, age at thelarche and time to menarche. Data were collected at baseline during a clinic visit, complemented with a mailed questionnaire and three 24 hour telephone dietary recalls, followed by annual follow-up questionnaires. Multivariable Poisson regression, linear regression and Cox proportional hazards regression were used to evaluate timing of pubertal development in relation to diet adherence.

New Jersey, USA.

Girls aged 9 or 10 years at baseline (2006–2014, n 202).

High Mediterranean-like diet adherence (score 6–9) was associated with a lower prevalence of thelarche at baseline compared with low adherence (score 0–3; prevalence ratio = 0·65, 95 % CI 0·48, 0·90). This may have been driven by consumption of fish and non-fat/low-fat dairy. Our models also suggested a later age at thelarche with higher Mediterranean-like diet adherence. Girls with higher Mediterranean-like diet adherence had significantly longer time to menarche (hazard ratio = 0·45, 95 % CI 0·28, 0·71 for high v. low adherence). Further analysis suggested this may have been driven by vegetable and non-fat/low-fat dairy consumption.

Consuming a Mediterranean-like diet may be associated with older age at thelarche and menarche. Further research is necessary to confirm our findings in other US paediatric populations and elucidate the mechanism through which Mediterranean-like diet may influence puberty timing.

The aim of the current study was to evaluate energy intake misreporting prevalence, its associated factors and its effects on nutrient intake, in the Portuguese population aged from 18 to 84 years.

Cross-sectional study.

Portugal.

Adults participants from the National Food, Nutrition and Physical Activity Survey, IAN-AF, 2015–2016, who provided two complete 24 h dietary recall and complete covariate information.

Under, plausible and over-reporters were identified according to the Goldberg method. Total misreporting prevalence was 29·9 %, being 28·5 % of under-reporting and 1·4 % of over-reporting. The current study found higher odds of being classified as an under-reporter especially in participants with higher BMI and in those who self-reported health perception status as non-favourable. Energy intake estimation increases by 853.5 kJ/d (204 kcal/d) when misreporters are excluded, and the same tendency is observed for macro and micronutrients. It is worth mentioning that the prevalence of inadequacy for protein intake decreases by about 5 % when considering plausible reporters.

The exclusion of misreporters has a small impact on the crude energy and nutrient estimates as well as on assessing the contribution of nutrients to total energy intake. However, a moderate impact was observed in the estimation of nutrient inadequacy prevalence.

To describe out-of-home consumption according to the purpose and extent of industrial processing and also evaluate the association between eating out and ultra-processed food consumption, taking account of variance within and between individuals.

Cross-sectional study.

Brazil.

The study was based on the Individual Food Intake of the Brazilian Household Budget Survey, carried out with 34 003 individuals aged 10 years or more, between May 2008 and May 2009. All food items were classified according to food processing level. The habit of eating out was evaluated through the frequency of days each individual reported eating out, described according to sociodemographic characteristics. The contribution of food energy per group and subgroup was estimated according to the frequency of eating out. In addition, multilevel modelling was employed to evaluate the association between eating out and ultra-processed food consumption.

In Brazil, culinary preparations accounted for most of the energy eaten out. However, it was possible to observe a higher contribution of ultra-processed foods, especially sugary beverages and ready-to-eat meals, as the frequency of out-of-home consumption increased. Compared with food consumption exclusively at home, eating out increased the consumption of ultra-processed foods by 0·41 percentage points within and between individuals.

In Brazil, the same individual and different individuals had greater consumption of ultra-processed foods when they ate out of home compared with when they ate at home. So, it is necessary to implement public policies which discourage the out-of-home consumption of ultra-processed foods and that provide affordable and accessible less-processed food options.

To examine the association between green tea and coffee intake and cognitive decline in older adults.

A prospective cohort study. The average intake of green tea and coffee in the previous year was assessed through a dietitian interview using a dietary questionnaire. A Mini-Mental State Examination (MMSE) was conducted up to six times biennially. Cognitive decline was screened using the MMSE; its incidence was defined as the first time a score of <27 points was obtained in a biennial test from the baseline. Hazard ratios for incidence of cognitive decline were estimated according to the intake of the two beverages using multivariable Cox proportional hazard regression, controlling for sociodemographic and lifestyle factors.

The National Institute for Longevity Sciences, Longitudinal Study of Aging (NILS-LSA) in Japan.

Men (n 620) and women (n 685), aged 60–85 years, from the NILS-LSA.

During a mean of 5·3 (sd 2·9) years of follow-up, 432 incident cases of cognitive decline were observed. Compared with participants who consumed green tea <once/d, the multivariable hazard ratio (95 % CI) was 0·70 (0·45, 1·06), 0·71 (0·52, 0·97) and 0·72 (0·54, 0·98) among those who consumed green tea once/d, 2–3 times/d and ≥4 times/d, respectively (Ptrend < 0·05). No significant association was found between coffee intake and cognitive decline.

The intake of green tea, but not coffee, was shown to reduce the risk of cognitive decline in older adults.

To explore the relationship between dietary patterns and risk of chronic kidney disease (CKD) in Chinese adults aged 45–59 years.

Dietary data were collected using a semi-quantitative FFQ. Factor analysis was used to identify the major dietary patterns. Logistic regression models were applied to clarify the association between dietary patterns and the risk of CKD.

The present study population was a part of the population-based Nutrition and Health Study performed in the city of Hangzhou, Zhejiang Province, eastern China.

A total of 2437 eligible participants (45–59 years) were enrolled in the present cross-sectional study from June 2015 to December 2016.

Three major dietary patterns were identified: ‘traditional southern Chinese’, ‘Western’ and ‘grains–vegetables’ patterns, collectively accounting for 25·6 % of variance in the diet. After adjustment for potential confounders, participants in the highest quartile of the Western pattern had greater odds for CKD (OR = 1·83, 95 % CI 1·21, 2·81; P < 0·05) than those in the lowest quartile. Compared with the lowest quartile of the grains–vegetables pattern, the highest quartile had lower odds for CKD (OR = 0·84, 95 % CI 0·77, 0·93; P < 0·05). In addition, there was no significant association between the traditional southern Chinese pattern and risk of CKD (P > 0·05).

Our results suggest that the Western pattern is associated with an increased risk, whereas the grains–vegetables pattern is associated with a reduced risk for CKD. These findings can guide dietary interventions for the prevention of CKD in a middle-aged Chinese population.

To assess the consumption of sugar-sweetened beverages (SSB) and other energy-dense nutrient-poor (EDNP) foods in two Southern low-income communities targeted by the Balance Calories Initiative, a campaign by the top-three American beverage companies intended to reduce the consumption of sugary beverages by 20 % over 10 years.

We conducted self-administered intercept surveys in front of food retail outlets between August and November 2016. We recruited adults with children <18 years living at home and adolescents aged 10–17 years with parental consent.

Retail food outlets in Mississippi and Alabama, USA.

Adults (n 11 311) and adolescents (n 3460).

The percentage of high SSB consumers (≥4 servings/d) was 40·9 % among adult males, 32·3 % among adult females, 43·0 % among adolescent males and 34·4 % among adolescent females (male – female difference, P < 0·0001). In aggregate, respondents also reported consuming a mean of 3 servings of salty snacks, cookies and/or candy in the past 24 h, with adolescent males reporting 4 servings.

SSB should be a primary target of future interventions to improve dietary intake, but EDNP foods likely contribute as many daily kilojoules as SSB among this population. Future campaigns should aim to limit the consumption of all EDNP foods.

To evaluate the association of ultra-processed food (UPF) consumption with gains in weight and waist circumference, and incident overweight/obesity, in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort.

We applied FFQ at baseline and categorized energy intake by degree of processing using the NOVA classification. Height, weight and waist circumference were measured at baseline and after a mean 3·8-year follow-up. We assessed associations, through Poisson regression with robust variance, of UPF consumption with large weight gain (1·68 kg/year) and large waist gain (2·42 cm/year), both being defined as ≥90th percentile in the cohort, and with incident overweight/obesity.

Brazil.

Civil servants of Brazilian public academic institutions in six cities (n 11 827), aged 35–74 years at baseline (2008–2010).

UPF provided a mean 24·6 (sd 9·6) % of ingested energy. After adjustment for smoking, physical activity, adiposity and other factors, fourth (>30·8 %) v. first (<17·8 %) quartile of UPF consumption was associated (relative risk (95 % CI)) with 27 and 33 % greater risk of large weight and waist gains (1·27 (1·07, 1·50) and 1·33 (1·12, 1·58)), respectively. Similarly, those in the fourth consumption quartile presented 20 % greater risk (1·20 (1·03, 1·40)) of incident overweight/obesity and 2 % greater risk (1·02; (0·85, 1·21)) of incident obesity. Approximately 15 % of cases of large weight and waist gains and of incident overweight/obesity could be attributed to consumption of >17·8 % of energy as UPF.

Greater UPF consumption predicts large gains in overall and central adiposity and may contribute to the inexorable rise in obesity seen worldwide.

To examine associations between protein intake per day and at different meals and skeletal muscle mass declines.

Two-year prospective cohort study among older community dwellers.

National Institute for Longevity Sciences–Longitudinal Study of Aging (NILS-LSA) in Japan.

Older men (n 292) and women (n 363) aged 60–87 years who participated in the baseline (2006–2008) and follow-up studies (2008–2010) of NILS-LSA and did not exhibit low skeletal muscle mass at baseline. Muscle mass was assessed using dual-energy X-ray absorptiometry at baseline and follow-up. Low muscle mass was defined as skeletal muscle mass index <7·0 kg/m2 for men and <5·4 kg/m2 for women at follow-up. Daily protein intake and protein intake at each meal were calculated from 3 d dietary records at baseline and sex-stratified tertiles were determined.

Mean (sd) protein intake at breakfast, lunch and dinner was 22·7 (7·8), 26·7 (9·3) and 37·4 (10·5) g for men and 19·3 (6·3), 23·2 (7·3) and 28·5 (7·0) g for women, respectively. After adjusting for age, baseline skeletal muscle mass and other confounders in logistic modelling, greater total protein intake was associated with lower prevalence of skeletal muscle mass decline among men at follow-up (P = 0·024). Particularly, the OR (95 % CI) for high lunchtime protein intake was low (0·11 (0·02, 0·61); P = 0·01). No significant association between total protein intake and prevalence of skeletal muscle mass decline was found among women.

High total protein intake, particularly at lunchtime, is associated with retention of skeletal muscle mass in men.

To assess the Na content and price of bread available in bakeries in the city of Maputo in 2018 and describe trends since 2012.

Cross-sectional evaluation of bread sold in twenty bakeries in the city of Maputo. Three loaves of white and three loaves of brown bread were collected from each bakery when available, and Na contents were quantified by flame photometry. To assess trends, samples of white bread collected in 2012 and analysed using the same methodology were compared with samples of white bread collected in 2018 from the same bakeries.

City of Maputo, capital of Mozambique.

In 2018, the mean (range) Na content in mg/100 g of white and brown breads were 419·1 (325·4–538·8) and 389·8 (248·0–609·0), respectively. Non-compliance with Na targets in bread according to the South African regulation (<380 mg/100 g) was observed in 70 % of white and 43 % of brown bread samples. A total of twelve bakeries had samples evaluated in both 2012 and 2018; among these, the mean Na content in white bread decreased by just over 10 % – the mean difference (95 % CI) was 46·6 mg/100 g (1·7, 91·5); and there was a significant increase of 3·7–5·4 meticais in the mean price per 100 g of white bread.

The Na content of bread available in bakeries in the city of Maputo decreased in recent years despite the absence of a specific regulation in Mozambique.

To analyse how much the intake of trans-fatty acids (TFA), an important dietary risk factor for CVD, changed among US children and adolescents over a period of time when food regulations that reduced the presence of TFA in the food supply were enacted.

Regression models were used to estimate changes in levels of TFA in plasma and other CVD risk factors among US children and adolescents from 1999–2000 to 2009–2010.

USA.

Nationally representative sample of children (aged 6–11 years) and adolescents (aged 12–19 years) who participated in the 1999–2000 and 2009–2010 cycles of the National Health and Nutrition Examination Survey.

Levels of plasma TFA declined significantly by an average of 61·9 % from 1999–2000 to 2009–2010. The average decline in a TFA commonly found in partially hydrogenated oils (elaidic acid, 67·2 %) was larger than the average decline in a TFA naturally occurring in ruminant animals (vaccenic acid, 60·5 %). Significant improvements in a variety of other CVD risk factors (LDL- and HDL-cholesterol, TAG, systolic and diastolic blood pressure, C-reactive protein) were also observed.

Between the two time points, 1999–2000 and 2009–2010, there were substantial decreases in plasma TFA levels and improvements in several other important CVD risk factors in the population of US children and adolescents.

The present study describes the energy content of primary-school children’s lunchboxes and the proportion of lunchbox foods considered discretionary. Subgroup analyses by sex, socio-economic status, age and weight status were undertaken.

A cross-sectional study was conducted. Mean kilojoule content, number of items and categorisation of foods and drinks in lunchboxes as ‘everyday’ (healthy) or discretionary (sometimes) foods were assessed via a valid and reliable lunchbox observational audit.

Twelve Catholic primary schools (Kindergarten–Grade 6) located in the Hunter region of New South Wales, Australia.

Kindergarten to Grade 6 primary-school students.

In total, 2143 children (57 %) had parental consent to have their lunchboxes observed. School lunchboxes contained a mean of 2748 kJ, of which 61·2 % of energy was from foods consistent with the Australian Dietary Guidelines and 38·8 % of energy was discretionary foods. The proportion of lunchboxes containing only healthy foods was 12 %. Children in Kindergarten–Grade 2 packed more servings of ‘everyday’ foods (3·32 v. 2·98, P < 0·01) compared with children in Grades 3–6. Children in Grades 3–6 had a higher percentage of energy from discretionary foods (39·1 v. 33·8 %, P < 0·01) compared with children in Kindergarten–Grade 2 and children from the most socio-economically disadvantaged areas had significantly higher total kilojoules in the school lunchbox compared with the least disadvantaged students (2842 v. 2544 kJ, P = 0·03).

Foods packed within school lunchboxes may contribute to energy imbalance. The development of school policies and population-based strategies to support parents overcome barriers to packing healthy lunchboxes are warranted.

The aim of the current study was to evaluate the effect on frequency, variety and amount of vegetables served and staff’s food-related practices in the multicomponent BRA intervention.

Cluster randomised controlled trial, conducted between Spring 2015 and Spring 2016. For allocation of the kindergartens, a stratified block randomisation was used. Data were collected in three ways: (i) a questionnaire for pedagogical leaders assessing the variety and frequency of vegetables served, including staff’s food-related practices assumed to be related to vegetable intake; (ii) a questionnaire for kindergarten assistants assessing staff’s food-related practices; (iii) a 5-d weighted vegetable diary assessing amount of vegetables served in a department.

The target group for this study was public and private kindergartens in the counties of Vestfold and Buskerud, Norway.

A total of seventy-three kindergartens participated.

At follow-up I, the amount of vegetables served increased by approximately 20 g per person per day (P = 0·002), and the variety in served vegetables increased by one-and-a-half kind per month (P = 0·014) in the intervention group compared to the control group. No effects on the frequency of vegetables served or on staff’s food-related practices were found.

The BRA intervention was successful in increasing the amount and variety of vegetables served within intervention kindergartens. Further research is needed to understand the mechanisms that can affect the staff’s food-related practices.

Extensive marketing of ‘toddler milks’ (sugar-sweetened milk-based drinks for toddlers) promotes unsubstantiated product benefits and raises concerns about consumption by young children. The present study documents trends in US toddler milk sales and assesses relationships with brand and category marketing.

We report annual US toddler milk and infant formula sales and marketing from 2006 to 2015. Sales response models estimate associations between marketing (television advertising spending, product price, number of retail displays) and volume sales of toddler milks by brand and category.

US Nielsen retail scanner sales and advertising spending data from 2006 to 2015.

Researchers analysed all Universal Product Codes (n 117·4 million) sold by seven infant formula and eight toddler milk brands from 2006 to 2015.

Advertising spending on toddler milks increased fourfold during this 10-year period and volume sales increased 2·6 times. In contrast, advertising spending and volume sales of infant formulas declined. Toddler milk volume sales were positively associated with television advertising and retail displays, and negatively associated with price, at both the brand and category levels.

Aggressive marketing of toddler milks has likely contributed to rapid sales increases in the USA. However, these sugar-sweetened drinks are not recommended for toddler consumption. Health-care providers, professional organizations and public health campaigns should provide clear guidance and educate parents to reduce toddler milk consumption and address misperceptions about their benefits. These findings also support the need to regulate marketing of toddler milks in countries that prohibit infant formula marketing to consumers.